List Archives

Mon Apr 30 17:45:12 BST 2007

No time like the present.  Unless the state EMS system takes a stand, New Jersey's trauma protocols will gradually defer to the ersatz leadership of MONOC and the Asbury Park Press.

I'm not suggesting the fix is easy, mind you.  Just that it's not optional.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Michael A Duchesneau, MD
Sent: Monday, April 30, 2007 10:27 AM
To: 'Trauma &amp; Critical Care mailing list'
Subject: RE: Trauma in the air Victims wait for help

EMS in New Jersey has always been a problematic concept. 

Ground and Air Services are continuously compromised by territorialism,
politics, and grossly outdated laws dating back decades. 

Until these items are fixed there can be no improvement.

--------------------------------------------------------------

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Forrest Robleto
Sent: Monday, April 30, 2007 10:12 AM
To: Trauma &amp, Critical Care mailing list
Subject: Re: Trauma in the air Victims wait for help

Expecting a helocopter to arrive after exactly how many minutes would
you drive instead?

On 4/29/07, Anthony caruso <medic541 at hotmail.com> wrote:
> Prêt, please tell me that crews did not wait on scene for the amount of
time
> that they stated?  28 minutes?  That's outrageous!  Shame on them if they
> delayed transport with an ETA like that.  I'm not sure how close they were
> to a level 1 trauma center (or level 2 for that matter) but if you figure
> that, add 28 minutes of flight time, plus the time it takes the crew to
land
> assess the patient, package and become airborne from the scene with that
> patient.  Looking at a time of possibly 36 minutes give or take?  Way too
> long for me anyway.  I do recall a statement in the protocols stating "do
> not delay transport".  What's your take?
> Anthony Caruso NREMT-P.
>
> >From: "Pret Bjorn" <p.bjorn at netzero.net>
> >Reply-To: "Trauma &amp; Critical Care mailing list"
> ><trauma-list at trauma.org>
> >To: "'Trauma &amp; Critical Care mailing list'" <trauma-list at trauma.org>
> >Subject: RE: Trauma in the air Victims wait for help
> >Date: Sun, 29 Apr 2007 08:46:16 -0400
> >
> >Well done, Forrest.  Good to be reminded that there're two sides to every
> >story.
> >
> >As I was scanning Steve's original post, it was easy to imagine the true
> >motives behind a competitive private air ambulance.  I think many states
> >have experienced similar rogue providers with varying results.
> >
> >A visit to www.monoc.org is instructive: their web site an electronic
> >monument to the Paramedical Industrial Complex.  Note the prominent
> >conservative icons: the Terror Threat barometer and the 9/11 memorial
> >(urging punishment for the terrorists and those who harbor them).
> >
> >Drilling further, it doesn't take long to find the "Save NJ Paramedics"
> >organization, whose mission it seems to declare New Jersey prehospital
care
> >on the brink of a disaster, which only unrestricted private billing can
> >resolve.  Even an amateur Google detective will soon discover that their
> >ostensibly grass-roots coalition is represented by Winning Strategies,
one
> >of the leading public relations firms in the northeast.
> >
> >In its proper context, the Astbury Park Press article is cynical and
> >sickening.  One can only hope that the good people of New Jersey wise up
to
> >the manipulation.
> >
> >
> >Pret Bjorn, RN
> >Bangor, ME USA
> >
> >
> >-----Original Message-----
> >From: trauma-list-bounces at trauma.org
> >[mailto:trauma-list-bounces at trauma.org]
> >On Behalf Of Forrest Robleto
> >Sent: Sunday, April 29, 2007 7:12 AM
> >To: Trauma &amp, Critical Care mailing list
> >Subject: Re: Trauma in the air Victims wait for help
> >
> >But there is more to the story....
> >
>
>http://www.app.com/apps/pbcs.dll/article?AID=/20070427/OPINION/704270390/10
3
> >0/POLITICS
> >
> >
> >On 4/29/07, S Schecter <schecters at gmail.com> wrote:
> > >
> > > Posted by the Asbury Park
> > > Press<
> > >
>
>http://www.app.com/apps/pbcs.dll/misc?URL=/misc/register_zago.pbs&Category=
z
> >ago&Destination=http%3A//www.app.com/
> > > >on
> > > 04/22/07
> > >
> > > BY JAMES W. PRADO ROBERTS <JWR at APP.COM>
> > > STAFF WRITER
> > >
> > > If your house is burning, the closest firefighters douse the flames.
> > >
> > > If a burglar is prowling, the closest police officer gives chase.
> > >
> > > If you are critically injured in an automobile accident and need to be
> > > airlifted to a trauma center, you'd think you would always get the
> >closest
> > > available medevac helicopter crew.
> > >
> > > Not in New Jersey.
> > >
> > > Across the state, victims of horrific auto accidents and other major
> > > trauma
> > > injuries have waited up to a half-hour longer than necessary for
> >state-run
> > > air rescue crews to reach them. Private medevac helicopters that are
> >much
> > > closer to some accident scenes are often deliberately not called by
> >state
> > > medevac dispatchers, the Asbury Park Press has found.
> > >
> > > At least 24 times since July, state medevac dispatchers sent a State
> > > Police
> > > helicopter to pick up seriously injured victims in Ocean and
Burlington
> > > counties, even though a closer medevac operated by MONOC could have
> > > arrived
> > > to fly the patients to a trauma center faster, according to MONOC and
a
> > > review of state medevac dispatch recordings.
> > >
> > > Patients in those cases faced delays of three to 28 minutes, according
> >to
> > > MONOC, a nonprofit regional emergency response organization, and
records
> > > reviewed by the Press.
> > >
> > > "I think it's a turf battle, and they are playing it with people's
> >lives,"
> > > said Assemblyman Peter J. Biondi, R-Somerset, sponsor of a bill that
> >would
> > > require the closest-available medevac to be dispatched to a trauma
> >scene.
> > >
> > > On at least two occasions, ground-based rescue crews canceled the
> >medevac
> > > and drove to a hospital rather than wait for a state helicopter,
> >according
> > > to Jeff Behm, MONOC's vice president of operations.
> > >
> > > In February, Miguel A. Flores of Toms River waited an estimated 17
> >minutes
> > > longer than needed for an air transport. A State Police helicopter was
> > > called first, even though a MONOC medevac craft was much closer.
Members
> > > of
> > > his family assumed that everything possible was done to help Flores,
who
> > > later died from his injuries.
> > >
> > > "I want to know what the heck happened," said his sister, Maritza
> >Flores.
> > > "We have been in the dark."
> > >
> > > The New Jersey State Police say their two medevac units have saved
> > > thousands
> > > of patients - including Gov. Corzine, who was seriously injured in a
> >motor
> > > vehicle accident April 12 on the Garden State Parkway. They also say
> > > private
> > > medevac operators aren't as safe, while MONOC said its program is as
> >safe
> > > or
> > > safer than any in the industry.
> > >
> > > "Our record speaks for itself. In every case we've delivered our
> >patients
> > > safely," said State Police spokesman Capt. Al Della Fave.
> > >
> > > Because traumas by their nature are life-threatening, no one has said
> >for
> > > sure if transportation delays led to permanent disability or death for
> > > patients in these cases.
> > >
> > > But at least two victims, Flores in Toms River, and another in Sparta,
> > > Sussex County, later died of their injuries in hospitals.
> > >
> > > Flores, 31, was critically injured shortly before 2 a.m. Feb. 22 when
> >his
> > > Toyota severed a utility pole adjacent to Hooper Avenue in Toms River.
> > > Flores was thrown through his driver-side window and landed 42 feet
> >away.
> > >
> > > At the time, MONOC's air ambulance was available seven miles away at
the
> > > Robert J. Miller Airpark in Berkeley, MONOC said.
> > >
> > > But the state's medevac dispatchers sent a New Jersey State Police
> > > helicopter dubbed SouthSTAR (Southern Shock Trauma Air Rescue). It was
> >42
> > > miles away in Voorhees.
> > >
> > > It took SouthSTAR 27 minutes to arrive, according to recordings of
State
> > > Police radio transmissions.
> > >
> > > MONOC says it could have been on the scene within 10 minutes.
> > >
> > > After SouthSTAR arrived, Flores' heart rate dropped, and he eventually
> > > needed CPR, according to the dispatch recordings. As a result, he
> >couldn't
> > > be airlifted to the region's trauma center, Jersey Shore University
> > > Medical
> > > Center in Neptune. Instead, an ambulance drove Flores to Community
> >Medical
> > > Center in Toms River, where he died at 3:21 a.m.
> > >
> > > Flores was in bad shape - and he may have died even if MONOC's
> >helicopter
> > > was dispatched, said Behm of MONOC. But because he was not flown to a
> > > trauma
> > > center by the closest medevac, there is no way of knowing, Behm said.
> > >
> > > In another accident, just after 10 a.m. on Sept. 17 in Sparta, Gary J.
> > > Wasilewski's motorcycle collided with a Honda CR-V. Paramedics at the
> > > scene
> > > asked that a nearby private medevac be dispatched, according to
> > > Assemblyman
> > > Biondi and dispatch recordings. It could have arrived in 12 minutes,
he
> > > said.
> > >
> > > The request was rebuffed by the dispatcher, who said, "You know what
the
> > > rules are, and I'm not gonna, with the atmosphere here, I'm not gonna
> > > change
> > > anything."
> > >
> > > The State Police's helicopter NorthSTAR, which had been in Mercer
> >County,
> > > didn't arrive until 27 minutes after it was dispatched, radio
recordings
> > > show.
> > >
> > > "The policy is State Police first; however, we expect dispatchers to
get
> > > the
> > > most appropriate helicopter there," said David W. Gruber, a senior
> > > assistant
> > > commissioner in the state Department of Health and Senior Services.
> > >
> > > When NorthSTAR brought the 54-year-old Wasilewski to the roof of
> > > Morristown
> > > Memorial Hospital, his heart stopped, according to Biondi. Wasilewski
> >fell
> > > into a coma and was taken off life support a week later, according to
> >his
> > > fiancee, Denise Danzeisen.
> > >
> > > "Why? Why? They were sitting right there," she said of the private
> >medevac
> > > helicopter located in Netcong and operated by the Atlantic Health
> >hospital
> > > chain. "Why couldn't they do it? It makes no sense."
> > >
> > > The state health department is currently reviewing its medevac
dispatch
> > > policy, and an independent consultant's report is due in June. It is
> >also
> > > reviewing whether the State Police should put a third medevac
helicopter
> > > into service in central New Jersey.
> > >
> > > NorthSTAR has been dispatched since 1988 by University Hospital in
> >Newark.
> > > The hospital took over dispatch responsibilities for SouthSTAR last
> >fall.
> > >
> > > Anna Farneski, a spokeswoman for the University of Medicine and
> >Dentistry
> > > of
> > > New Jersey, which operates University Hospital, declined to comment on
> > > specific dispatches, citing patient privacy laws. The Press asked
> > > specifically about dispatch decisions, not patients' conditions.
> > >
> > > "We are unable to address misinformation disseminated by those who
would
> > > turn New Jersey's medevac service into a for-profit enterprise,"
> >Farneski
> > > said.
> > > *
> > > First hour is critical*
> > >
> > > It's called the golden hour.
> > >
> > > Since the Vietnam War, emergency medical professionals have maintained
> > > that
> > > 60 minutes can mean the difference between life and death for the
> > > critically
> > > injured.
> > >
> > > Beginning in 1988, the New Jersey State Police have safely flown
> >thousands
> > > of patients to trauma centers within that time. State health
department
> > > policy gives the State Police a virtual monopoly over air rescues, as
> >long
> > > as a helicopter is available.
> > >
> > > Private operators are called only if the state's medevac helicopters
> >can't
> > > respond, according to official dispatch rules and state policy
letters.
> > >
> > > Most other states rely on private medevac operations to ferry the
> > > critically
> > > injured to trauma centers. But until two years ago, NorthSTAR and
> > > SouthSTAR
> > > - the State Police's two helicopter rescue units - had operated here
> > > virtually without competition.
> > >
> > > Last year, the agency's medevac helicopters responded to 1,261
accident
> > > scenes, and transported another 314 patients from one medical facility
> >to
> > > another.
> > >
> > > But to settle a lawsuit, in 2004 New Jersey decided to allow private
> > > medevac
> > > helicopters to be based in the state. There are now three private air
> > > ambulances in the state, including MONOC's, which had its first flight
> >in
> > > April 2006.
> > >
> > > By way of comparison, Maryland State Police, who pioneered nonmilitary
> > > medevac operations in 1970, also relegate private medevac helicopters
to
> > > accident scenes only if the Maryland police can't respond. But
Maryland
> > > State Police ferry five times the number of trauma victims that New
> >Jersey
> > > State Police do, with eight medevac helicopters on standby throughout
> >the
> > > state. Maryland has only a third more land and fewer residents - 5
> > > million,
> > > compared to 8.7 million in New Jersey.
> > >
> > > "We can have a helicopter anywhere in the state from 12 to 18
minutes,"
> > > said
> > > First Sgt. Richard Bruns, flight operations supervisor for the
Maryland
> > > State Police.
> > >
> > > The Sikorsky helicopters used by the New Jersey State Police for
medevac
> > > operations, originally built to fly CEOs, not patients, are larger and
> > > faster than some private air ambulances: At a cruising speed of 150
> >knots,
> > > the State Police medevac could fly from the tip of Sandy Hook to the
tip
> > > of
> > > Cape May in 41 minutes - 4 minutes and 30 seconds
> > > faster than MONOC's Eurocopter, which has a cruise speed of 135 knots.
> > >
> > > But MONOC - which is owned and operated by a consortium of 20
hospitals
> > > from
> > > Hudson to Cape May counties, including Jersey Shore - says it is wrong
> >for
> > > the state health department to force trauma patients to wait longer
for
> > > the
> > > State Police when another helicopter is closer.
> > >
> > > "This is a no-brainer," Behm said. "This needs to be changed now."
> > >
> > > MONOC's medevac does respond when SouthSTAR is unavailable, and Behm
> >said
> > > MONOC's helicopter has seen an increase in accident scene calls since
> > > Flores
> > > died on Feb. 22.
> > > *
> > > Assembly bill considered*
> > >
> > > In March, Assemblyman Herb Conaway Jr., a medical doctor, held a
hearing
> > > on
> > > a bill similar to Biondi's that would require the state to dispatch
the
> > > closest medevac helicopter to a trauma scene.
> > >
> > > Conaway, D-Burlington, asked Dr. Eric Munoz, a fellow member of the
> > > Assembly
> > > Health and Senior Services Committee, who teaches at UMDNJ and is a
> >trauma
> > > surgeon at University Hospital: "You are the trauma doc here. . . .
Does
> > > 10
> > > minutes matter?"
> > >
> > > Munoz, R-Union, responded: "I don't think I've had once where I've
said
> >if
> > > the helicopter got there earlier, this person would be alive. . . .
I've
> > > been working in Newark 20 years, I can't remember an incident."
> > >
> > > Other agencies measure response times in seconds.
> > >
> > > In New York City last April, officials announced that a pilot program
to
> > > install global positioning satellite equipment in ambulances had
reduced
> > > its
> > > emergency medical response times to the most serious calls by just 33
> > > seconds. The city then spent nearly $50 million to install the
equipment
> > > in
> > > 1,565 emergency response vehicles.
> > >
> > > "In an emergency," New York Mayor Michael Bloomberg said at the time,
> > > "every
> > > second counts."
> > > *
> > > Financial incentives?*
> > >
> > > The question of which helicopter is asked to respond to trauma calls
is
> > > not
> > > just a question of patient care, as MONOC maintains - it's also a cash
> > > competition, some say.
> > >
> > > While the State Police itself does not charge patients for the
flights,
> > > the
> > > hospitals that provide in-flight medical staff charge a flat fee of
> >$1,337
> > > for each patient. A typical private medevac fee for an auto accident
> > > victim
> > > is $8,000 or more, most of which is paid for by insurance.
> > >
> > > The State Police medevac program is suppose to be funded by an annual
> > > vehicle registration fee surcharge, which increased from $1 to $3 in
> >July.
> > >
> > > The medevac's revenue would have increased to $21.5 million, which
could
> > > have been used to replace the State Police's aging Sikorsky S76-B
> > > helicopters. However, most of the money was diverted into the general
> > > treasury for other purposes. This year, the medevac unit will receive
> >the
> > > same amount of money as it did in 2006 - approximately $8.5 million.
> > >
> > > In addition to trauma rescue, the medevac helicopters perform various
> > > police
> > > and security missions. The most junior State Police trooper pilot will
> > > receive a $56,820 salary this year, according to Capt. Della Fave.
There
> > > are
> > > 22 medevac pilots.
> > >
> > > Hospitals that supply medical personnel on the flights will receive a
> > > total
> > > of $2.5 million billing this year from the state, on top of the
$817,000
> > > they expect from patient flights.
> > >
> > > The hospitals involved in the program are University Hospital, Virtua
> >West
> > > Jersey Hospital in Voorhees and Cooper University Hospital in Camden.
> > >
> > > >From 2001 through 2006, University Hospital and Virtua received $10.2
> > > million from the state, not including as much as $5 million more in
> > > patient
> > > billings. Last year, the hospitals won a three-year grant to continue
> >the
> > > service. Income to the hospitals was expected to be $3.3 million this
> > > year.
> > >
> > > The real reason private operators want to be called first, said Dr.
> >Steven
> > > Ross, chief of Cooper's trauma unit, is that auto accident victims in
> >New
> > > Jersey have good insurance policies that will pay for medevac
services.
> > >
> > > "You want my honest answer? It's a pure and simple profit motive.
> >There's
> > > money to be made," Ross said.
> > >
> > > Stephen D. Olsen, MONOC's chief flight paramedic, disagrees.
> > >
> > > "What we think this is is a patient care issue. If there was a fire,
> >you'd
> > > want the closest fire truck," he said. "This is the same thing."
> > > --
> > > trauma-list : TRAUMA.ORG
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> >
> >
> >
> >--
> >V/R
> >
> >Forrest Robleto
> >R House Health & Safety
> >www.RHouseTraining.com
> >FRobleto at RhouseTraining.com
> >609-792-9047
> >--
> >trauma-list : TRAUMA.ORG
> >To change your settings or unsubscribe visit:
> >http://www.trauma.org/index.php?/community/
> >
> >
> >
> >--
> >trauma-list : TRAUMA.ORG
> >To change your settings or unsubscribe visit:
> >http://www.trauma.org/index.php?/community/
>
> _________________________________________________________________
> Mortgage refinance is Hot. *Terms. Get a 5.375%* fix rate. Check savings
>
https://www2.nextag.com/goto.jsp?product=100000035&url=%2fst.jsp&tm=y&search
=mortgage_text_links_88_h2bbb&disc=y&vers=925&s=4056&p=5117
>
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>

-- 
V/R

Forrest Robleto
R House Health & Safety
www.RHouseTraining.com
FRobleto at RhouseTraining.com
609-792-9047
--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

--
trauma-list : TRAUMA.ORG
To change your settings or unsubscribe visit:
http://www.trauma.org/index.php?/community/

List Archives

For your convenience, find the Trauma List Archive Below

Trauma in the air Victims wait for help